THE IMPACT OF FAM-FFC UPON ADVERSE OUTCOMES IN HOSPITALIZED PERSONS WITH DEMENTIA

Abstract The Fam-FCC education and coaching of care partners emphasizes optimizing physical and cognitive function and detection of changes in condition to prevent falls, avoidable transfers to the emergency department and hospital readmissions. Thus, the aim of this study was to examine the impact of Fam-FFC upon the desired outcomes of less transfers to the emergency department, hospital readmissions, and falls. The majority of patients identified as female, with an average age of 81.5 (± 8.4); approximately 64% were White patients and 36% were Black or African American patients. The sample indicated, on average, moderate impairment in cognition (MMoCA=11.7±7.0) and baseline (pre-admission) some impairment in physical function (MBI=78.1±22.6), mild pain (MPAINAD=0.79±1.5) and depression (MCESD=9.1±6.2). There were no group differences in transfers to the emergency department; however intervention participants were approximately 10% less likely to be hospitalized (p<.04) over the study intervention. The total number of falls or transfers to the emergency department did not differ between groups. The findings of this study suggest that Fam-FFC may be implemented without increasing the risk of falls, while possibly decreasing hospitalizations.

symptoms, and delirium severity did not differ by treatment arm.Preparedness for caregiving increased significantly more from 2 months to SE=.439,d=.563;changecontrol=.893,SE=.450,d=.212,overall p = .02),and marginally increased from discharge to six months.(changeintervention= 2.783,SE= 0.44,d=.682;changecontrol=1.695,SE=0.44,d=0.415,overall p =0.08), in the intervention group, with no group differences in anxiety, strain, and burden.Fam-FFC may prevent some of the postacute functional decline and behavioral symptoms in persons with dementia while increasing FCP preparedness.Future research should focus on sustainability of patient improvements and addressing the chronic stressors associated with the care partner role.At the time of hospital discharge, family care partners are typically planning to deal with the increased care dependency and medically complex needs of the person living with dementia.Consequently, they experience compounded stress to their psychological wellbeing.This study examined patient and care partner factors associated with family care partners' anxiety, depression, and burden when caring for patients with dementia at hospital discharge.The sample consisted of 434 patient and care partner dyads enrolled in the Family centered Function-focused Care (Fam-FFC) study.Multiple regression analyses were conducted to examine factors associated with care partners' anxiety (Hospital Anxiety and Depression subscale anxiety; HADS-A), depression (Hospital Anxiety and Depression subscale depression; HADS-D), and burden (Short Form Zarit Burden Interview; ZBI-12).Care partner anxiety was associated with higher levels of patient behavioral and psychological symptoms of dementia (BPSD; β=.13; p = <.001).Care partner depression was associated with cohabitation (β=1.30;p = <.001), and patient factors including increased BPSD (β=.17; p = <.001) and lower function (β=-.03;p = <.001).Care partner burden was associated with care partner relationship with patient (adult child; β=-.27; p = .02)and higher patient BPSD (β=.67; p = <.001).Findings suggest the need to incorporate the functional and behavioral status and needs of the patient when preparing the care partner for discharge, which may be especially critical if the patient is discharged to the care partner's residence.

THE IMPACT OF FAM-FFC UPON ADVERSE OUTCOMES IN HOSPITALIZED PERSONS WITH DEMENTIA Barbara Resnick, University of Maryland, Baltimore, Maryland, United States
The Fam-FCC education and coaching of care partners emphasizes optimizing physical and cognitive function and detection of changes in condition to prevent falls, avoidable transfers to the emergency department and hospital readmissions.Thus, the aim of this study was to examine the impact of Fam-FFC upon the desired outcomes of less transfers to the emergency department, hospital readmissions, and falls.The majority of patients identified as female, with an average age of 81.5 (± 8.4); approximately 64% were White patients and 36% were Black or African American patients.The sample indicated, on average, moderate impairment in cognition (MMoCA=11.7±7.0) and baseline (pre-admission) some impairment in physical function (MBI=78.1±22.6),mild pain (MPAINAD=0.79±1.5)and depression (MCESD=9.1±6.2).There were no group differences in transfers to the emergency department; however intervention participants were approximately 10% less likely to be hospitalized (p<.04) over the study intervention.The total number of falls or transfers to the emergency department did not differ between groups.The findings of this study suggest that Fam-FFC may be implemented without increasing the risk of falls, while possibly decreasing hospitalizations.The quality of care greatly depends on the quality of interactions between staff and hospitalized older adults with dementia which in turn can be influenced by many factors.This paper examines the clinical factors associated with the quality of interactions between staff and hospitalized older adults with dementia.Following the examination of bivariate associations, we conducted multiple linear regression in a sample of 140 hospitalized older patients with dementia who participated in the final cohort of Fam-FFC.On average, the participants (male = 46.1%,female = 52.9%)were 81.43 years old (SD = 8.29) and had positive interactions with staff.Accounting for 17.5% of the variance in the model, non-pharmacological interventions (b= 0.181; p<.001) and pain (b= -0.201; p<.01) were significantly associated with the quality of staff-patient interactions.To optimize care of hospitalized patients with dementia, staff should be encouraged to use non-pharmacological interventions and prioritize pain management in patients.

ASSOCIATION OF BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA WITH ADVERSE OUTCOMES POSTHOSPITALIZATION Diane Berish, The Pennsylvania State University, University Park, Pennsylvania, United States
In hospitalized persons with dementia, behavioral and psychological symptoms of dementia (BPSD), also known as behavioral symptoms of distress, are associated with increased morbidity, long-term care admissions, and reduced care partner well-being.The Fam-FFC study provided the opportunity to examine the association between BPSD severity and adverse, post-acute outcomes (falls, emergency department transfers, hospital admissions).Logistic regression analysis examined the association of behavioral symptoms (Neuropsychiatric Inventory Questionnaire, NPI) and odds of having a fall, emergency department transfer, and hospital admission, controlling for the intervention, and caregiver and patient characteristics.NPI scores decreased from admission (M = 7.81, SD = 6.12), to discharge (M = 6.4,SD = 5.93), to two months (M = 5.38, SD = 5.91), to six-month follow-up (M = 5.08, SD = 5.94).Higher admission NPI scores were associated with greater odds of experiencing at least one fall (OR = 1.067, p = 0.042) by discharge.Higher discharge NPI scores were associated with higher odds of ED transfer (OR = 1.062, p = 0.006) and at least one hospitalization (OR = 1.06, p = 0.008) after two months.Higher NPI scores at 2-month follow-up were associated with increased odds of ED transfer (OR = 1.062, p = 0.004), experiencing at least one injury (OR = 1.055, p = 0.031), falls (OR = 1.056, p = 0.012), and hospitalizations (OR = 1.065, p = 0.004) at six months.Results underscore the importance of providing interventions to reduce BPSD as a potentially modifiable risk factor to reduce adverse outcomes.

MARITAL TRANSITIONS IN MID AND LATE LIFE
Chair: Joan Monin Discussant: Jason Newsom Marital transitions are common in mid and late life, yet little is known about what makes some middle aged and older adults thrive and others experience hardship through these transitions.This symposium will discuss antecedents, consequences, and moderators of adjustment to marital transitions in mid to late life.Monin and colleagues will address antecedents of divorce/separation, presenting results from a case control study showing that later stage dementia is associated with a lower likelihood of divorce/ separation, and certain neuropsychiatric symptoms are associated with a greater likelihood of divorce/separation.In terms of consequences of relationship dissolution, Bourassa and colleagues will present findings from a study across a 20-year period of adulthood, showing that people with more breakups in adulthood have more advanced biological age in midlife.Two studies will discuss moderators of associations between relationship transitions and well-being.Carr and Choi will discuss the experiences of childless older adults who become widowed or divorced, and whether they suffer poorer mental health than their peers with children.They will show that childless widowed men and divorced men who lost a child to death have dramatically higher levels of social loneliness, relative to other men.Finally, Scheffer and colleagues will talk about the transition out of dementia spousal caregiving.They will present findings indicating that although caregivers' emotional well-being and energy improves from moving from being an active caregiver to moving out of the caregiving role, those with lower household income had worse outcomes after caregiving ended.

CLINICAL FACTORS ASSOCIATED WITH THE QUALITY OF INTERACTIONS BETWEEN STAFF AND HOSPITALIZED PERSONS WITH DEMENTIA Anju
Paudel, Penn State Ross and Carol Nese College of Nursing, State College, Pennsylvania, United States